Rise in Domestic Violence Seen in Areas Near Bars

by Michael Smith Michael Smith North American Correspondent, MedPage Today
February 17, 2012

Action Points

Explain that increased density of bars and pubs in a neighborhood was found to correlate with emergency department visits for intimate partner violence.

Note that the presence of liquor stores or groceries correlated with a slight decrease in ED visits for domestic violence, and restaurants serving alcohol had no effect.

The more bars and pubs there are in a neighborhood, the more likely are incidents of domestic violence that end up in the emergency department, researchers reported.

On the other hand, liquor stores and groceries that sell alcohol appeared to be associated with a slight protective effect against cases of serious intimate partner violence, according to Carol Cunradi, PhD, and colleagues at the Prevention Research Center in Berkeley, Calif.

And the presence of restaurants that serve alcohol had no effect either way, Cunradi and colleagues reported online and in the May issue of Alcoholism: Clinical & Experimental Research.

The key message, Cunradi said in a statement, is that environmental factors -- such as the number of bars and pubs -- affect the risk of intimate partner violence.

She and her colleagues noted that there is extensive evidence linking the number of bars and pubs in a neighborhood with community assaults, and heavy drinking has been associated with violence between partners.

To extend the research, they looked at the density of alcohol outlets by ZIP code in California, and correlated the data over 3.5 years with emergency department visits that were coded as resulting from intimate partner violence.

"While a handful of international studies have looked at the geographic association between (intimate partner violence) and neighborhood conditions, this is the first study in the U.S. documenting a relationship," commented Richard Scribner, MD, of Louisiana State University in New Orleans, who was not involved in the research.

And the study is "innovative," he said in a statement, because it uses statewide data, only available in California, that compiles emergency department visits for domestic violence.

Previous studies, he and Cunradi noted, have typically used police reports, which tend to vary in reliability from department to department.

Also, Cunradi noted, emergency department visits by their nature tend to be the more serious incidents of violence, while police reports can include everything from shouting to assault.

The researchers compiled half-yearly numbers of emergency department visits for each ZIP code in the state, between the last half of 2005 and the end of 2008, for a total of seven reporting periods.

At the same time, they used Bayesian statistics to correlate those figures with the numbers of alcohol-selling establishments in an area and to account for changes in ZIP code boundaries over time.

They found:

An increase of one bar or pub per square mile was associated with a 3% increase in the risk of an emergency department visit for intimate partner violence (RR 1.03, 95% CI 1.015 to 1.047).

Conversely, an increase of off-premise outlet per square mile was associated with a 1% reduction in the risk (RR 0.990, 95% CI 0.982 to 0.999).

The presence of restaurants had no effect.

The first and last findings were expected, Cunradi and colleagues noted, since people go to restaurants, even those that serve alcohol, for different reasons than they go to a bar.

"We expect that restaurants that also sell alcohol are frequented by (people) primarily to have a meal that may or may not be accompanied by alcohol," Cunradi said in a statement. "On the other hand, we expect that bars/pubs are primarily frequented by men with or without their female partners, with the primary goal of drinking alcohol."

But the apparent protective effect of off-premise liquor sales, which is not consistent with previous research, was surprising and needs further investigation, the researchers said.

One possible explanation, they argued, is that liquor from such establishments is drunk at home and so is "less likely to result in physical aggression than alcohol consumed in the bar environment."

Cunradi and colleagues cautioned that the study relies to some extent on correct coding at emergency departments and noted that factors not accounted for in the analysis may also play a role.

The study had support from the National Institute on Alcohol Abuse and Alcoholism. The authors did not report any potential conflicts.

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